Adult-onset Still's disease differential diagnosis: Difference between revisions

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!Diseases
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! colspan="7" |Signs and symptoms
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|Fever
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|Myalgia
| rowspan="2" |Myalgia
|Soft tissue swelling
| rowspan="2" |Soft tissue swelling
|Skin rash
| rowspan="2" |Skin rash
|Weight loss
| rowspan="2" |Weight loss
| rowspan="2" |Dyspnea
| rowspan="2" |Sore throat
| rowspan="2" |Lymphadenopathy
| colspan="2" |Inflammatory markers
| rowspan="2" |Complete blood count (CBC)
| rowspan="2" |Liver function tests (LFTs)
| colspan="4" |Autoantibodies
|Diagnostic tests
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|Erythrocyte sedimentation rate (ESR)
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|Anti-nuclear antibodies (ANA)
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| rowspan="9" |Infections
| HIV
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|Borreliosis, Brucellosis, Yersiniosis
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| rowspan="3" |Neoplasia
| rowspan="3" |Neoplasia
|Malignant lymphoma
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|Multicentric Castleman disease
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|Angioimmunoblastic T cell lymphoma
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|Drug hypersensitivity
|Drug hypersensitivity
|Drug reaction with eosinophilia and systemic symptoms
|Drug reaction with eosinophilia and systemic symptoms
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| rowspan="8" |Autoimmune conditions
| rowspan="8" |Autoimmune conditions
|Systemic lupus erythematosus
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|Idiopathic inflammatory myositis
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|Reactive arthritis
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| rowspan="3" |Miscellaneous
| rowspan="3" |Miscellaneous
|Sarcoïdosis
|Sarcoïdosis
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|Kikuchi–Fujimoto disease
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Revision as of 13:16, 25 April 2018

Adult-onset Still's disease

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Differentiating Adult-onset Still's disease from Other Diseases

Differentials based on fever, fatigue, arthralgia, myalgia, rash and soft tissue swelling

Adult-onset Still's disease (AOSD) is a diagnosis of exclusion and other conditions presenting with fever, fatigue, arthralgia, myalgia, rash and soft tissue swelling should be excluded if a diagnosis of AOSD is suspected clinically. The differentials include the following:

Diseases Signs and symptoms Laboratory findings
Fever Fatigue Arthralgia Myalgia Soft tissue swelling Skin rash Weight loss Dyspnea Sore throat Lymphadenopathy Inflammatory markers Complete blood count (CBC) Liver function tests (LFTs) Autoantibodies Diagnostic tests
Erythrocyte sedimentation rate (ESR) C- reactive protein (CRP) Anti-nuclear antibodies (ANA) Rheumatoid factor (RF) Anti- glomerular basement membrane (anti-GBM) Anti-dsDNA
Infections  HIV + + + + +/- - + - - - -
 Herpesviridae
 Measles, rubella…
 Viral hepatitis
 Parvovirus B19
Infective endocarditis Blood cultures, ultrasonography
Borreliosis, Brucellosis, Yersiniosis Serology, PCR
Mycoplasma pneumoniae, syphilis … Serology, PCR
Toxoplasmosis Serology, PCR
Neoplasia Malignant lymphoma CT, PET/CT, Bone marrow examination, lymph node biopsy
Multicentric Castleman disease Lymph node biopsy
Angioimmunoblastic T cell lymphoma Lymph node biopsy
Drug hypersensitivity Drug reaction with eosinophilia and systemic symptoms Eosinophil count, skin biopsy
Autoimmune conditions Systemic lupus erythematosus Antinuclear autoantibodies
Idiopathic inflammatory myositis Idem, muscle biopsy
Rheumatoid arthritis Anti-citrullinated peptids autoantibodies, rheumatoid factor
Systemic vasculitides ANCA, tissue biopsy, arteriography
Familial Mediterranean fever Familial history, MEFV gene analysis
Mevalonate kinase deficiency Urinary mevalonic acid, mevalonate kinase analysis
TNF receptor-associated periodic syndrome TNFRSF1A gene analysis
Reactive arthritis HLA B27, magnetic resonance imaging
Miscellaneous Sarcoïdosis
Neutrophilic dermatosis
Kikuchi–Fujimoto disease

Differentials based on arthritis

Adult-onset Still's disease (AOSD) should be differentiated from other causes of fever and polyarthralgia/arthritis of the peripheral skeleton. The differentials include the following:[1][2][3][4]

Arthritis Type Clinical Features Body Distribution Key Signs Laboratory Abnormalities
History of Psoriasis Symmetric joint involvement Asymmetric joint involvement Enthesopathy Dactylitis Nail Dystrophy Human immunodeficiency virus association Upper extremity-hands Lower extremity Sacroiliac joints Spine Osteopenia Joint Space Ankylosis Periostitis Soft tissue swelling ESR Rheumatoid factor (RF) HLA-B27
Psoriatic arthritis + + ++ + + + + +++ (DIP/PIP) +++ ++ (Unilateral) ++ - ++ (Widening) ++ +++ (Fluffy) ++ + - 30-75%
Rheumatoid arthritis - ++ + - - - - +++

(MCP/wrist)

+++ + (Unilateral) ++(Cervical) +++ +++ (Narrowing) + + (Linear) +++ +++ +++ 6-8%
Reactive arthritis (Reiter's syndrome) - +++ - + + - - ++ +++ ++ (Unilateral) + + + (Narrowing) - +++ (Fluffy) ++ ++ - 75%

Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent

References

  1. ↑ Helliwell PS, Taylor WJ (March 2005). "Classification and diagnostic criteria for psoriatic arthritis". Ann. Rheum. Dis. 64 Suppl 2: ii3–8. doi:10.1136/ard.2004.032318. PMC 1766878. PMID 15708931.
  2. ↑ McEwen C, DiTata D, Lingg C, Porini A, Good A, Rankin T (1971). "Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study". Arthritis Rheum. 14 (3): 291–318. PMID 5562018.
  3. ↑ Helliwell PS, Hickling P, Wright V (March 1998). "Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?". Ann. Rheum. Dis. 57 (3): 135–40. PMC 1752543. PMID 9640127.
  4. ↑ Moll JM, Haslock I, Macrae IF, Wright V (September 1974). "Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome". Medicine (Baltimore). 53 (5): 343–64. PMID 4604133.

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